Abstract: Introduction: Studies have shown that incorporating ancillary providers such as nurses and certified diabetes educators (CDEs) is beneficial in the treatment of diabetes and its comorbidities. In this study, we assessed whether people with diabetes, following treatment protocols implemented by CDEs have a greater reduction in their Patient Healthcare Questionnaire (PHQ9) scores compared to those in usual care group.

Methods: The study was a cluster randomized trial that recruited 15 practices in Pittsburgh which were randomized to intervention or usual care. Demographic, clinical and laboratory characteristics were measured at baseline, 3, 6 and 12 months. PHQ9 scores were measured at each follow up visit. Linear mixed effect models were used to compare the groups.

Results: There were no major differences in baseline demographic characteristics among the treatment groups except for race (P=0.01). The baseline HbA1c was significantly higher in the treatment group compared to the control group (mean=8.8% versus 8.2%, P=0.02). There was no significant difference in depression scores between the two treatment groups at the end of the study (β = 0.8, P=0.23). Repeating the analysis using multiple imputation did not change the overall results. Factors that reduced the depression score significantly were use of antidepressants, quitting smoking and absence of microvascular complications (P <0.0001).

Conclusion: We can conclude that diabetics who were managed by CDEs did not have a better improvement in their depression score compared to those in usual care, however treatment of depression and avoiding complications are important. Including treatment for depression using standard protocols should be examined in future research. Summary: We conducted a cluster randomized study to determine if people with diabetes, following treatment protocols implemented by Certified diabetes educators have a greater reduction in their Patient Healthcare Questionnaire (PHQ9) scores compared to those in usual care group. We found no significant reduction in PHQ9 scores after 1 year of follow up.References: Frayne, S. M., Halanych, J. H., Miller, D. R., Wang, F., Lin, H., Pogach, L., . . . Rosen, C. S. (2005). Disparities in diabetes care: Impact of mental illness. Archives of Internal Medicine, 165(22), 2631-2638